How Can Professionals Learn to Reduce Fears of Psychotic Experiences Rather Than Emphasize Pathology?

The kinds of experiences we call psychotic are often incredibly scary: people feel they are being persecuted by strange forces, or that their brains have been invaded by demons or riddled with implants from the CIA . . . the list of possible fears is endless, and often horrifying.

While standard mental health approaches counter many of these fears, they often create new fears of a different variety. People diagnosed with schizophrenia for example may be led to believe that they will definitely be mentally ill for life, that this illness controls what happens in their brain and not themselves, and that there are few or even no alternatives if drugs don’t work for them.

This can be extremely demoralizing. Oryx Cohen graphically described his own reaction to the standard mental health psychoeducation he received after his first psychotic experience: he reported it made him feel he had lost his membership in the human race! As a result of it, he felt caught up in a pathologized understanding of himself, he lost his expectation of being capable of learning from experience and shaping his future, and he now felt defined by his abnormality rather than by his humanity.

Despite − rather than because − of what the mental health system taught him to believe, Oryx later discovered other ways of understanding his experience, and he made a full recovery. But wouldn’t it be better if people like Oryx were helped to find a more humanistic understanding of themselves within the mental health system and from the very beginning of treatment?

Wouldn’t it be helpful if professionals were trained in an approach that could help people shift away from both dangerous psychotic ways of thinking and also away from the sometimes equally terrifying explanations which emphasize pathology?

Further, what if such an approach could also build a foundation for learning effective coping skills, and also help a person build hope and a road map toward a possible full recovery?

And wouldn’t it be nice if this approach was already proven to be “evidence based,” so that both people learning the methods, and their supervisors and colleagues could have confidence in its effectiveness and safety?

Fortunately, at least one such approach exists, and it is called CBT for psychosis. This method allows professionals to collaborate with people in developing understandings of their psychotic experiences that neither minimize problems nor emphasize pathology, but instead help make sense of extreme human experiences in a way that is grounded in more everyday human experience and issues.

And, better yet, those of you who are interested don’t need to go out and buy something, or travel to a seminar somewhere, in order to learn this method: instead, an online training module on normalizing is now being made available, for free!*

To access this training, I’m asking that you first register with my email list at this link, then you will be instructed on how to sign up for the training module itself.

Here’s an outline of what you can learn from participating in this training module:

Grasp the full picture of what normalizing consists of and what it can accomplish

Shape the concepts and language you use to understand and explain psychosis, so that normalizing and realistic hopes for recovery will be supported each step of the way within mental health treatment

Understand how normalizing explanations can help people shift from life destroying “vicious circles” to the “virtuous circles” associated with recovery

Learn ways normalizing can go wrong, and how to avoid those mistakes

Watch normalizing in practice, and begin to experiment with putting it into use

* This training module is one part of a complete basic course in CBT for psychosis that will be made available later this year for a modest fee that will include CE credits for most professionals.

I hope those of you who are interested in helping people with psychosis do consider taking this relatively brief training! I believe those of you who are new to this approach will find it extremely valuable, while those who are already familiar with many of the components will still benefit from the review and will likely find some new angles on the approach.

So, again, to access this training, I’m asking that you first register with my email list at this link, then you will be instructed how to sign up for the training module itself. Signing up for the email list will insure you are notified when the entire CBT for psychosis course becomes available.

Dialogues with Madness: A therapist and educator specializing in cognitive therapy for psychosis, Ron Unger explores emerging understandings of psychosis and of efforts to change mental health treatment to support human rights and full recovery.

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I just found out it is possible that the links above won’t work if you are already on my email list, so if you suspect that is the case and you are having problems registering for the free training, you could try this link instead -http://smnr.me/n8diio

To E.Silly and anyone else who gets to the page that says “Start Here” and then can’t get further: you may have a problem due to having an an old browser, or maybe it’s because you have turned off javascript or cookies, If it’s due to an old browser, it could be fixed by getting a more current browser.
If you need more help than what I am providing here, you could try contacting Julia at [email protected]

I’m using recent browsers. It seems to be a problem with siminar, their external javascripts are not loading properly. Somehow I’ve managed to watch the video after I successfully signed up with one browser and copying then the URL to another browser.

Natasha Campbell McBride poignantly states that Marijuana does in fact precipitate psychosis in young people. In relation to what Mr. Unger is stating above, the message here is that more important than avoiding putting these young people in “diagnostic boxes” is to avoid the treatment of these young people with powerful drugs.

With time and restorative health care these young people can recover their wellness, while labeling them, and then giving them powerful drugs – puts them on the downward slope of never getting off the powerful drugs and never being restored to a healthy life.

Cannabis is stated, in a manner that is convincing, by Natasha Campbell-McBride in this video given at the Weston Price Foundation to, in actual truth, be an “environmental factor,” an important contributing factor, in peoples Medical and Psychological troubles.

This for very many people unfortunately leads to young people being put in a “diagnostic box” and given potent drugs. The view that marijuana should be treated as minor and innocuous – which was legally adopted in Britain – turned out to be a mistake. Such is true of marijuana only for the majority who are not already health compromised as many young people these day are.

Many people’s first break into psychosis is predicated by marijuana use. This actually suggests that people need respite, time and care so that they can restore their health and even greater health than they had previously.

“Which means that those toxins had enough time to bombard the brain. and to cause organic damage in the brain.”

“When we do scanning — there’s a very sophisticated scan called PET Scan — when we do PET Scan on severely autistic children of the age of 3 to 5, we find perfectly normal brain.”

“These children are born with perfectly normal brains.”

“To reverse this is much harder.”

“When these children grow up — GAPS doesn’t disappear, unless it hasn’t been treated.”

“And, then they get to teenage years, and the young adulthood — and substance abuse is one of the venues these children usually take.”

“You know that about ten years ago, British Government pronounced cannabis to be a less damaging substance — and so it became more available to our youngsters.”

And Psychiatrists began ringing the bell, and they still ringing the bell, and it doesn’t seem to make any difference, that they seeing growing numbers of youngsters develop first episode of psychosis, after the first use of cannabis.”

“These are GAPS children.”

“I’m sure you all know teenagers who go to parties, smoke cannabis, and they’re fine.”

“But these are GAPS children. They’re vulnerable.”

“Cannabis can start a psychotic episode, in these children, and that then leads to diagnosis of schizophrenia, being sectioned, being put on very potent medication – and that’s a slippery slide – for the rest of your life.”

“Once you get hooked on those medications, it is very difficult to get off those things.”

I agree that for some people at least, marijuana can cause psychotic experiences.

I can tell a tale myself that illustrates that effect. When I was in high school, I started hanging out with a friend who really really liked to smoke pot, starting in the AM and then at noon and at breaks, with the really serious smoking starting once school got out. After I got going in that style myself for a few weeks, I recall attending a party, where of course we smoked pot. At some point during this affair, I started to realize that the conversations I was hearing people have in my head were actually very different than what the people were actually saying, which I could still tune into if I really paid close attention.

this was very weird and disorienting. Fortunately though I came up with a normalizing explanation – I decided it must be the pot, I hid the weird experience I was having from others so they wouldn’t think I was crazy, and over the next few days or weeks the experience faded as I smoked much less marijuana, and tried very hard to pay attention to what people were really saying instead of the dialogue in my imagination.

With that said, I think the overall relationship between marijuana and psychosis may be quite complex, and there definitely are people who report that smoking pot reduces distressing psychotic experiences, and there’s even a substance in marijuana, CBD, that would probably be being tested right now as an antipsychotic if there wasn’t the problem that no one can get a patent on it.

So I think we need to increase awareness that marijuana can cause problems for particular individuals as suggested, and we need to get better at helping people in a constructive way when they have those experiences, but I don’t think re criminalizing marijuana will be a helpful step. Putting people in prison causes horrible human and social costs, without much benefit. So I’m for awareness, not prison…….

Pot indeed works in weird ways- I have worked with people where pot was one of the main factors in instigating a psychotic episode and I have worked with people where pot was the best tool for eliminating manic episodes. Its a complex plant with numerous constituents that can be both relaxing and stimulating, psychoactive and tranquilizing. I think it depends a lot on potency, how frequently it is used, personal biochemistry as well as “set and setting.”

Inmy practice I am more likely to see people stimulated into psychosis by synthetic canibinoids…nasty drugs known as “Spice” and “K2”.

From what I’ve heard from more adventurous friends it’s true for pretty much every drug of abuse including most psychiatric drugs. You simply cannot predict what a person would feel like on a given substance before hand and it also changes with time and circumstances. I’m for legalisation and regulation of drugs so people at least have some idea what they buy and consume and the public stops freaking out about it but develop some understanding of what the effect could be. This can only help everyone.

I think the point is: every psychotic experience has different origins. For some people it will be psychological, for other it can be induced by drugs or physical illness/deficiency. Even lack of sleep can induce hallucinations. Problem is when the person is taken to see a psychiatrist and is immediately diagnosed with something that “requires lifelong drug treatment”. Drugs should be the last resort and only for people who want to take them.
When it comes to marihuana legalisation I’m totally for it. Alcohol, caffeine and tobacco are legal and they cause at least if not more health problems than pot – aggression after drinking is contributing to crime and domestic abuse big time. Just put warning labels and don’t treat everyone who gets a bit crazy on it as a case of “incurable lifelong illness”. People will try and hopefully realise that if you’re starting to hear voices maybe it’s not for you.

I still don’t know what I should think of marijuana in relation psychosis. My gut feeling tells me, that it would help me to relax and sleep, if I ever had psychotic experiences. Then I know at least one guy who went voluntarily to the psychiatric hospital, after smoking marijuana and got psychotic. On the other hand I have the impression that some people using marijuana for managing their symptoms (like others use legal psychiatric drugs).

The best framework for me to understand the different experiences and views is the drug centred model (which Joanna Moncrieff describes). Drugs are unspecific and have different effects on different people. I know people who didn’t take Zyprexa, because it caused hallucinations.

I read that marijuana has anti-inflammatory effects and that it not only acts on neurons, but also on astroglial cells (astrocytes). So we still don’t know enough how these drugs work in detail (marijuana, neuroleptics, SSRI).

What we know is that there is a link between gut and brain (inflammation and nutrition).

The dopamine 2 receptor blocking drugs (major tranquillizers, neuroleptic drugs such as haloperidol and risperdal) came out in 1954 with the first one chlorpromazine and so plenty is known by now – or would be – if not for the saturation of disinformation from special interests.

CBD and THC are turning out to be neuroprotective and anti-inflammatory aren’t they? That’s great – while there are other plants of interest (skullcap, Hypericum perforatum, turmeric, etc.) which ought to be kept in sight in the overarching bigger-picture topic, however important or specific in application this recent CBD information is.

The idea that the mode of action of the profitable marketed psychiatric drugs is one of drugging the brain and disabling the brain in a manner that is non-specific – the same for any person subjected to the drug – is an idea expounded upon by David Jacobs, Ph.D., Peter Breggin, M.D. and Joanna Moncrieff, M.D.

This differs at times from the information and commentary from the integrative, restorative, orthomolecular researchers and clinicians. The drug St. John’s wort for instance may not be frowned upon.

The idea of chemotherapy in Psychiatry is supported by them with much emphasis on amino acids, essential vitamins, minerals and fatty acids. (Or in Natasha Campbell-McBride’s case emphasis on Gut health!)

While the biochemical Psychiatrists note that, “The benefits of psychiatric medications are often exaggerated and the risks minimized. A very common side effect of psychiatric medications is death.” The major tranquillizer drugs are known to them to be more specific than is known to the psychosocial theorist Psychiatrists.

“Overmethylation results in reduced expression of DAT and excessive dopamine activity. This biochemical abnormality is a hallmark of paranoid schizophrenia.”

If a person has overmethylation then their as it were “dopamine level” can be “too high.” While this makes them a subgroup for which the “antipsychotic medications” could be called more specific, in actuality what they need is to have the methylation tested for and addressed!

With the new material from Natasha Campbell-McBride she tells of further health consideration other than permanently sedating the person as the “treatment” once they have a breakdown.

Then too with so-called antidepressant sales items: Raising serotonin such as by using B-6 and mangnesium or by using L-Tryptophan is looked on more favorably by integrative Medical people as compared to say Robert Whitaker and Joanna Moncrieff who might tell us that the serotonin idea was just wrong and disproved.

They state, there is a subgroup for which SSRI drugs have better patient response – undermethylators and pyrolurics.

The biochemical treatment people are better with dealing with chemical concepts in an analytical, contemplative manner than the psychosocial theorists.

Eric Braverman, M.D. at PATH Medical Clinic writes that while there is menopause that there are likewise a number of as he says “pauses” where different systems can be worn down or “old.” So for Braverman testing of serotonin functioning in the brain might show that the system
serotonin functioning is weak. While SSRI patent drugs might not be the usual thing to recommend, still if, in a particular person’s case, the serotonin system was seen in the testing to be very weakened then a powerful SSRI drug might be used.

That cells need to communicate to stay alive is an operative concept here. Building up the health of the system is one idea… yet if the system is very weakened then this consideration might apply.

I can’t recently find Eric Braverman, M.D. stating use of of SSRI drugs. Still the idea that the one or another system can be weak (such as the serotonin system) is in his work.

Anyway the point is that the drug model criticism is good but needs to be rounded out with other references to other important items.

Drugs have a range of impacts (the commonly stated ones, plus others) these can be nonspecific or (in a limited sense) more specific, or else-wise important in some way (anti-inflammatory, anti-oxidant, antibiotic, antiviral, anti-fungal.)

The gut and brain link is some cutting edge material. I saw William Walsh speak at the Salem Hospital and he told how by repairing the metallothionein system young people with Autism were getting well. He said that their are immature neurons that finsh maturing in the brains of 20 something year olds once their metallothionein system is healthy. This was gut and brain.

There’s a lot to look at in terms of the nutrition/mental health connection. At the same time, for the lion’s share of people I think underlying poverty, classism and lack of adequate housing and support systems trump diet.

At the same time, we have created a global food system based on creating obesity, inflammation and disease- both physical and mental. Transforming the psychiatric industry requires also transforming the global food industry to stop poisoning us.

wiley witch–it’s possible that islanders have higher rates of suspectability to psychosis are more likely to seek out housing in whiter neighborhoods (whether because they have more stressful jobs and make more money and thus live in a wealthier area, or they are marginalized by their own community for some reason, and so on).

“Drugs are unspecific and have different effects on different people.”
Bingo. And it’s even more complex for natural substances which aren’t pure but rather mixes of different compounds with different properties (much like drugs cocktails prescribed for mental patients).

I’ve never really smoked myself, but I’ve mixed with lots of cannibis/skunk smokers, and funny thinking is now so normal in smokers, that most nonsmokers allow for it.
My experience is that the ‘anti psychotics’ manufacture long term mental illness through their withdrawal syndromes. But, its possible to withdraw very carefully, and at the same time build a defense system that copes with the long term damage.

Stimulants also produce psychosis big time and it’s not a new discovery – the potential of amphetamines to induce weird experiences and hallucinations is well known from the people who use it as recreational drug and performance inducing drug. But when you give it to people nicely packed in a pill and call it ADHD medicine the side effects magically become rare or non-existent while the drug unmasks the underlying illness.

Hi Ron
Great post, ‘psychotic experience’ might actually be normal, but admitting to it is taboo. I get a picture of Clint Eastwood tracking down an offender, and finishing him off when I hear the word ‘Psychotic’.

What I think is, that psychotic symptoms can be dependent on a reasoning process that supports distress. For example being very worried about losing a job, can be as distressing as thinking the CIA are bugging the phone.

I’m not sure you can call psychosis normal but it’s certainly one of the ways people react to chronic stress and trauma. It’s the minority of people, depression, detachment or aggression are more common responses and they have also been turned into “mental illnesses”. I wonder what a “normal, healthy” response to bad things in your live should be according to the DSM?

“As a society, we live with the unbearable by pressuring those who have been traumatized to forget and by rejecting the testimonies of those who are forced by fate to remember. As individuals and as cultures, we impose arbitrary term limits on memory and on recovery from trauma: a century, say, for slavery, fifty years, perhaps, for the Holocaust, a decade or two for Vietnam, several months for mass rape or serial murder… In The Book of Laughter and Forgetting, Milan Kundera writes that ‘The struggle against power is the struggle of memory against forgetting.’ Whether the power is a fascist state or an internalized trauma, surviving the present requires the courage to confront the past, reexamine it, retell it, and thereby remaster its traumatic aspects… to the extent that bearing witness reestablishes the survivor’s identity, the empathetic other is essential to the continuation of a self.” (Aftermath, 57-9)

Thanks, wileywitch, very important points, great quote. Our society’s intolerance for people being still upset with what happened in the past shows up in lots of areas, even in the way one is allowed less and less grief after the death of a loved one, before it is defined as something that requires a drug.

Ron,
For anyone that recognizes my posts to various MIA articles since joining this community after the horrific death of my 25 y/o beautiful, 6’4″ son, 3o months ago, I have strongly associated cannabis and psychosis together. ( I joined MIA after finding RW’s book Anatomy…Epidemic following my son s death when I finally found answers to the hell my son suffered with the MH wastelands for the 27 months once my son, overnight, descended into altered thinking, admitting he had been using cannabis which he believed- like pretty all of society especially this young generation- it was ” harmless”, ” just a herb”). Do I think my son was hit with the perfect storm of adversity (leading him to use cannabis ) prior to his first loss of reality? Yes! Do I believe, for his young brain, cannabis triggered two ‘episodes’ of psychosis ( defined in his medical records) twice, 18 months apart,both times hosp in two different psych facilities , both times his toxicology report (+) for THC. Absolutely!! Did any p-doc accept the research I found re:cannabis and psychosis? NOPE- just label, medicate into a drugged, stuporous state, brainwash, stigmatize ” mentally ill for life, bipolar for life”. I challenged the “experts” upon my son’s 2nd ‘ episode’ how can his symptoms abate, almost exactly as the same time period: 10 wks when his brain to returned to ” normal”. These ” experts” only lectured ” accept your son is mentally ill”. Why once he returned to his ” normal” mental health did ALL bizarre behavior disappear I asked them? Who knew marijuana has been so altered genetically & cultivated hydroponically from the hippie days? Did my son know how potent the strain of cannabis he had used? Did he, and his social group, know today’s cannabis has so much THC ( the mind-altering substance) and so less CBD ( supposedly the anti-psychotic property) : of course not!!!! To label a young man, so accomplished, so loved, with such a charismatic way with a lifelong MI, instead of IDENTIFY how cannabis is negatively affecting SOME young, developing brains ( ESP < 25):CRIMINAL!!!

I’m sorry for your loss…
I remember meeting a guy in a psych ward who was locked up there for marihuana possession – basically given a choice of a jail sentence and permanent criminal record or “treatment”. He didn’t even have any psychotic symptoms, he was a completely normal guy and was not even addicted to anything – just a standard recreational user who happened to be caught. Guess what happened to him: as he complained to the staff that he couldn’t sleep (in the same room with 7 different guys who were snoring etc.) he was given heavy duty sleeping pills known to cause addiction and severe side effects. He was also given other “medicine”. I bet he came out of that hospital in a much worse mental and physical state than he went in there. It’s freaking madness what is going on…

The average potency of pot has more than tripled in the past two decades, according to testing done for the federal government. This comes just over a year after Colorado and Washington legalized the drug and as many other states consider making it legal for medical or recreational use.

Scientists determine potency by measuring levels of THC, or delta-9-tetrahydrocannabinol, the main psychoactive ingredient that gives marijuana its “high.” And data from the University of Mississippi’s Potency Monitoring program found that the average potency of marijuana has jumped from 3.4 percent THC in 1993 to 12.3 percent THC in 2012. Scientists at the lab say they’ve seen samples as high as 36 percent.

This month’s “High Times” magazine, with a cover promoting “The Strongest Strains on Earth,” claims to have analyzed 15 strains of pot with potencies ranging between 25 to 28 percent THC. Marijuana near that strength can be bought at many legal retail shops and medical dispensaries across the U.S.
—————

THC is lipophilic ( fat loving and the brain is a fatty organ). I will forever believe the ” experts” should have known my son’s rapid descent twice, 18 months apart, both ‘episodes’ testing ( +) for THC ( which is the ingredient that causes the high) in those two different psych facilities ( the last psych hosp was for my son to receive drug rehab once we found out he returned to using cannabis yet he was coerced to their locked unit, brainwashed ” bipolar for life” until he was ” dumped” ) instead of recognizing my son was suffering from effects of THC on his young, still developing brain. Shouldn’t we start recognizing this travesty is happening? I’m apolitical at present about marijuana, but surely education to the masses, particularly this young generation, better begin. It’s too late for my son.

Hi, Ron,
Great initiative and something new to add to the growing “other ways” of looking at and handling psychosis. I am aware that you are beginning to give online courses and asked a friend who first alerted me to your course if it was just for “professionals.” Apparently members of the public are welcome to take it, she said. (I think it was there in the fine print when I checked a couple of months ago.) Could you confirm if this is correct? I think it’s important for the wider public to know about this course and to not be dissuaded by thinking it’s for “professionals” only
Thanks,
Rossa

Lovely article Ron, but in the past the CIA did put implants in peoples brains such as a hard wired transceiver/transmitter that CIA operative Mark Phillips described in various testimony including his books and on TV interviews about it. It allowed voices to be sent into a persons head that only they could hear. Also DARPA has poured lots of money recently into developing new chip implants to control peoples emotions and thoughts, which is being worked on all around the country including at UCSF (one use will be to treat mental illness but the other to control people, to restrain targets perhaps to torture them). The CIA also literally kidnapped children and had them raped and abused, drugged, kept in cages, electroshocked, dosed with radiation, and programmed as spy assassins and prostitutes in the past, and there are confirmed more than 100,000 adult and child victims of military mind control programs in the past. And those are just the ones prove able from FOIA documentation, and everything since the 1970s remains classified but apparently continued. There are some legit targets who have been in mind control programs their whole lives so by definition those types of things are not necessarily delusion or psychotic in nature.

Modern mind control tends to use signals intelligence to imping peoples bodies with signals and radiation, hurting targets of government abuse, allowing heterodyning of signals into a persons brain and nerves to alter function, which is often misdiagnosed as paranoia and psychotic symptoms even when its real. Whistleblower Dr. Robert Duncan who designed the systems to do it has been prominent reporting these abuses, that the government is doing this to people. His audio and video interviews and the backing patents and articles on NSA can be found at http://www.OregonStateHospital.net/d/story.html#nsabrainlink

It is possible a legit target could be messed up so badly from the attacks that he truly sounds like he has schizophrenia and psychosis but this is why they invented the weapon because it was so easy to hide its use when they wanted to be able to fuck citizens up. It is very concerning to think about.

Nice program of education, too. I think treatment like this should be the standard for the people who actually need help, instead of drugs, and drugs shouldn’t even be an option for treatment. Just my insightful opinion. Psychodynamic psychotherapy is good, too. Leisure and extreme sports activity and outdoor fun is another thing people need more of, too, just to stay focused in non mental health stuff.

Thanks for this excellent resource, Ron. Great way to get the word out. One way to “normalize” that I find useful is asking professionals to self-disclose an experience when they were severely distressed and thinking & feeling was impacted. A recent post on MIA noted how just sleep deprivation alone can readily produce psychotic-like experiences.
Some prof’s are hesitant, but acknowledging we are all vulnerable under stress moves the conversation away from illness and pathology towards improving coping.

Good point Wayne. Having those kinds of self disclosures happen is an important part of CBT for psychosis, and in the training module on normalizing, i ask everyone to think of, and hopefully share, experiences like the ones you talk about.